Can nursing thrive in the age of the coronavirus? What young people think about the profession

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Can nursing thrive in the age of the coronavirus? What young people think about the profession

This article is part of a series in which OECD experts and thought leaders – from around the world and all parts of society – address the COVID-19 crisis, discussing and developing solutions now and for the future.

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This article was co-authored by Vanessa Denis, Statistician, Directorate for Education and Skills, OECD.

“Save one life, you’re a hero. Save 100 lives, you’re a nurse,” so the saying goes. The coronavirus (COVID-19) pandemic has certainly reminded us just how important nursing is. It is a profession that touches all our lives. Many public surveys describe nurses as the most trusted professionals. The World Health Organisation’s (WHO) inaugural State of the World’s Nursing 2020 published last month calculates that there are some 28 million nurses around the world, but needs are growing and, on current recruitment trends, a shortfall of 6 million nurses by 2030 is projected. Drawing on data from 191 countries, the study set out the need for 8% annual increases in the number of nurse graduates to tackle the current and anticipated shortages.

The WHO brings forward ten recommendations to equip the world with the nursing workforce it needs. They focus on nursing pay, conditions and work organisation. What’s missing however, is a consideration of whether young people understand modern nursing and express any interest in pursuing it as a profession.

How do young people see the nursing profession?

Since the start of this century, a raft of research reviews has found that young people’s interests in nursing are commonly based on misperceptions and often highly gendered. A 2019 international literature review commissioned by the Australian government concluded:

Although the nursing profession is one of the most trusted, the community still sees it as an occupation with few career opportunities, requiring little intellectual capacity and no academic qualifications, with low status and a lack of professional autonomy. The public’s trust appears to be attached to the image of nursing as a vocation, and of nurses as self-sacrificing, altruistic and noble, rather than knowledgeable practitioners in a contemporary profession.

Studies find that young people often hold perceptions of nursing which are unrealistic and old-fashioned. This even applies to students who have expressed interest in joining the profession with consequences for their retention in training programmes. Such attitudes are driven in part by distorted media images, but also because in many countries over the last generation, nursing has changed significantly as a profession. It is now commonplace, for example, for entrants to need a bachelor’s degree and for nurses to occupy leadership positions with considerable responsibilities.Studies reveal ingrained attitudes which underestimate the responsibilities that come with nursing. As one Finnish focus group student explains:

My mother always told me not to choose nursing because she doesn’t want me to change incontinence pads.

Recent analyses of the recruitment challenges faced by nursing have moreover highlighted its highly gendered composition. Historically, the profession has overwhelmingly drawn new recruits from only half the world’s population: women. 

The new nurses of 2030 are currently in secondary school, and OECD PISA data help shed light on the challenge facing recruiters. The 2018 PISA asked representative samples of 650,000 young people, aged 15 in 79 countries and economic areas, what job they expected to have at age 30. The tables below set out young people’s interest in becoming Nursing Professionals, Midwifery Professionals and Associate Professional Nurses in OECD and non-OECD countries. 

Graph: OECD
Graph: OECD

On average, across the OECD countries, around 3 in 100 young people anticipate going into nursing. In Costa Rica, Estonia, Georgia, Italy, Latvia, Lithuania, Moldova, Qatar, Russian Federation, Saudi Arabia, Turkey, the United Arab Emirates and Viet Nam less than 1% of respondents who have an occupational expectation are thinking of nursing. Within the OECD, students in the United States are 68 times more likely to express an interest in nursing than Latvian students. 

PISA 2018 data also break down interest by gender. Across all countries, considerably more girls express interest in nursing than boys. The ratio between girls’ and boys’ interests, however, vary substantially between countries. In OECD countries, 92% of those young people who anticipate going into nursing are female.

Graph: OECD
Graph: OECD

Across the OECD, 8% of boys anticipated entering nursing. A small number of countries buck the trend. Outside of the OECD, in Brazil, Croatia, the Dominican Republic and Lebanon, more than 20% of interest in nursing comes from boys. Within the OECD, it is only Luxembourg where such levels of interest are expressed. In many OECD countries, including countries that pride themselves on applying a gender lens in public policy such as Denmark, Norway and the United Kingdom, less than 2% of the young people who imagine themselves in nursing are boys. The pattern is especially acute in Eastern Europe where in many countries negligible numbers of male students cite nursing as their occupational expectation. Further analysis of PISA 2018 data, moreover, is in line with research literature. Nursing is particularly attractive to girls who perform more weakly on the PISA academic assessments, are drawn from lower socio-economic classes and are foreign-born.   

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A consistent message in the research literature on young people’s interest in nursing is the need to ensure that young people have the opportunity to gain realistic understandings of what contemporary nursing entails. Better information, notably through first-hand experiences of nursing through career talks/role models, job shadowing and work placements, is seen as essential to enable the widest possible range of young people to develop an informed understanding of what nursing has to offer as a profession, clarifying any misperceptions and challenging stereotypes. Providing authentic and trustworthy insights into the occupation is important, as is the need to work closely with career counsellors. This is particularly true today, and the experiences of nurses on the frontline should be listened to. One US study, which reviewed testaments from 69 guidance counsellors in light of the pressing need for greater flow of young talent into nursing, concluded:

Based on the results of this study the researchers implore nurses and school counselors to form a strategic alliance to enhance career exploration. By collaborating, counselors and nurses can share the responsibility of a common goal of disseminating knowledge and keeping current with professional agendas which impact career preparation. Nurses should ask to be part of the career fair and use their social capital within the community to show students all the career paths nurses can have. If the nursing profession does not embrace the influence school counsellors have on students' futures and support K-12 career development programs, nurse leaders may well be faced with even larger shortages of talented nurses.

As the coronavirus crisis increases the visibility of the nursing profession, this is advice relevant to healthcare and education systems in all countries.

For more information:

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Future of Work

Future of Education & Skills

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